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Interoperability Concerns Bedevil Electronic Health Records

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According to physicians, electronic health records suffer from an interoperability problem that must be overcome before the technology’s potential can be fulfilled.

Mitch Morris, M.D.

Back around 1990, I became aware of the potential of electronic health records (EHRs). The ability to use this technology to improve efficiency, effectiveness, quality, and safety felt like it was around the corner, and I shifted my career away from medicine and toward enabling greater adoption. Now, more than 25 years later, there are still challenges. Sure, we have made great progress, but as an industry we still seem far from the goal line.

This is what Deloitte’s 2016 Survey of U.S. Physicians found. The majority of physicians we surveyed hold relatively negative perspectives on some aspects of EHRs, and this has not improved since our last survey in 2014. Indeed, 3 out of 4 physicians believe that EHRs increase practice costs, outweighing any efficiency savings, and 7 out of 10 physicians think that EHRs reduce their productivity. Moreover, physicians are less likely to think that EHR capabilities support clinical outcomes than they were in the 2014 survey.

This doesn’t mean that the Health Information Technology for Economic and Clinical Health (HITECH) Act’s Meaningful Use program—which gave bonuses to clinicians who adopted certified EHR systems—has been unsuccessful. Case in point: Most physicians (78 percent) believe that EHRs are most useful for analytics and reporting, compared with other attributes (such as supporting value-based care or improvements to clinical outcomes); this has also increased since the 2014 survey. In fact, few physicians would stop using their current EHR system: 3 out of 5 said they would keep it.

What the survey did find, however, is that nearly all physicians would like to see improvements. Their wishes fell into two major areas:

62 percent want EHRs to be more interoperable

57 percent want improved workflow and increased productivity.

These last points will likely be critical as we enter into the first phase of implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). EHRs and interoperability are a fundamental aspect of virtually every part of this initiative. For example, while Meaningful Use will be phased out for eligible professionals, the U.S. Centers for Medicare and Medicaid Services (CMS) has replaced it with the Advancing Care Information measure under the new Merit-Based Incentive Payment System (MIPS). MIPS is for clinicians who do not meet Advanced Alternative Payment Model (APM) thresholds, and for most of the categories under it, clinicians will be able to report using their EHR, too. Clinicians in Advanced APMs will not be able to avoid it, either—only payment models that use certified EHR technology will qualify under the Advanced APM definition.

Interoperability is also getting increased attention under MACRA. The president of the American Medical Association, Steven Stack, has said that the lack of interoperable systems is one of the fundamental reasons why the potential of EHRs has gone unfulfilled. For that reason, and likely others, Congress made interoperability a core focus of MACRA. This comes after years of work by the Office of the National Coordinator for Health Information Technology (ONC), the Healthcare Information and Management Systems Society (HIMSS), and others to enhance data sharing and transparency across the system.

Health care’s reliance on technology is not likely to change. In fact, MACRA’s emphasis on using and enhancing EHR systems and the charge to improve interoperability moving forward could strengthen the focus on technology. But our study and others like it indicate we still have work to do before health IT delivers a clear and discernable value similar to what many enjoy in the world of online retail shopping.

Not unlike the practice of medicine itself, effective implementation of EHRs can be part science and a healthy dose of art. The art component includes our ability to manage change, train clinicians in a holistic way, transform workflow, and truly take advantage of automation. We may get there, but we should consider the strong notes of concern from the clinical community.

Interoperability Concerns Bedevil Electronic Health Records

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